The Supreme Court of B.C. has decided there will be no judicial review of a ruling regarding an end-of-life care case that happened in Nanaimo.

A man calling on a provincial health tribunal to reverse a ruling on a case involving his now-deceased mother had his application for judicial review dismissed by the Supreme Court of B.C. last week.

The case involves Thomas William Sanders’s mother, Arleane, an 80-year-old double amputee who experienced pressure ulcers, wound infections and extreme pain, and doctors including Robin Love, a palliative care physician in Nanaimo, according to court documents.

Arleane was admitted to Nanaimo Regional General Hospital multiple times between November 2014 and March 2015 according to the documents, which state that Love was one of the doctors who provided care to her during her time at NRGH.

Prior to admission to NRGH, Arleane spent months living at Nanaimo Seniors Village, where she required daily dressing changes and “often screamed in pain” and one doctor wrote that staff overmedicated her so that “she would not be a nuisance,” court documents show.

In November 2014, the son had become concerned about the side effects of pain medication his mother was taking, which included opioids. Thomas, described in court documents as a “well-intentioned” man, had become so concerned that he believed the opioids his mother was taking were causing her to experience “delirium” and that she was being over-medicated to the point where she could no longer eat or drink. It was at that point that Love was brought in to address issues of pain management and medication options, as well as conflict between the son and hospital staff, according to court documents. Arleane had granted her son permission to give or refuse consent to medical care on her behalf through a representation agreement in 2013.

By early March 2015, Arleane was admitted to NRGH following the development of a large open cavity and there was no possibility of treating it, according to court documents, which also state that Thomas refused to consent to increasing Arleane’s pain medication and disagreed with Dr. Love and hospital staff over pain management plans. Nurses at NRGH were “distressed and tearful” and found it hard to provide care because Thomas interfered with their ability to provide painkillers.

On March 6, 2015, Love, who has more than 20 years of experience, called the son and told him his mother was in extreme pain and dying and needed better pain medication to reduce her suffering. Thomas disagreed, believing that Love was not acting in Arleane’s best interests.

Thomas’s decision-making privileges were eventually taken away by Love following advice from multiple health organizations including Vancouver Island Health Authority, as well as a legal opinion. Thomas filed a complaint to College of Physicians and Surgeons of British Columbia against Love, arguing that the doctor’s actions violated the Health Care Professions Act, that end-of-life care had begun without proper consent and that he was improperly removed as his mother’s representative.

In the final days before her death, the doctor said nurses treating Arleane were “completely traumatized” and that one nurse had witnessed the woman crying for two days. Love told Thomas that his “personal ethics and morals mandated that he provide proper pain medication.”

Arleane died on March 22, 2015.

Following her death, the College of Physicians and Surgeons of B.C.’s inquiry committee conducted an investigation into Thomas’s complaint against Love. After the inquiry committee ended up dismissing the complaint in 2016, Thomas contacted the Health Professions Review Board, which determined the committee’s investigation had been adequate.

Thomas filed a application for judicial review with the Supreme Court of B.C. last year, seeking to have the review board’s decision quashed and to have the board rule that Love breached his professional obligations.

Last week, the Supreme Court dismissed the application for judicial review. In his decision, Justice Michael Brundrett noted that this case was not a “clear situation in which a physician plainly acted illegally against the wishes of a representative” and that the Health Professions Review Board’s decision was transparent and justifiable.

Although the Vancouver Island Patient Care Quality Review Board determined in 2016 that “it does not appear that the hospital had the right to revoke or override” the son’s representation agreement with his mother, the Supreme Court decision concluded that the inquiry committee was entitled to their finding that Love’s conduct was “satisfactory.”

The inquiry committee, the HPRB and the Supreme Court did not make a legal finding over the issue of consent that had been raised by the petitioner.